In 1999 The Swedish Society for Old Age Psychiatry conducted an investigation in all Swedish counties in order to survey existing organizations and resources for medical services intended for elderly people with psychiatric complaints. In some counties there were no out-patient units specifically aimed at elderly people with psychiatric diseases, while more than half had no out-patient units for the large group of elderly with psychiatric ailments other than dementia. The total number of beds was far less than international recommendations. Less than 5 per cent of the total number of Swedish psychiatrists and geriatricians hold positions exclusively for geriatric psychiatry. Access to geriatric psychiatry resources appears to be unevenly distributed, and may be found mainly in or near university cities.

During recent decades psychiatric health care has become increasingly complex due to substantial clinical improvements and to the growing need of integrating psychiatric services with other health and welfare services in the community. The traditional psychiatric record format is incompatible both with these requirements and with the practical advantages and difficulties of modern computer technology. In a collaborative effort involving most professional categories at three psychiatric units in the county of Västerbotten in northern Sweden, a new structured format for medical records was developed. The basic feature is a structured summary of background factors, social situation, drug habits, and general health, which is reviewed and updated as necessary. The psychiatric condition is described in some detail, including onset and course, symptomatology, personality factors, diagnosis, treatment results, suicidality, etc. Day to day treatment is outlined in in- and out-patient treatment plans, which are evaluated and revised at regular intervals. The new record format, which is used by all categories of health care professionals, is intended to promote goal-directed treatment and professional collaboration, and is easily adapted to computer technology.

The annual incidence rate of high grade malignant glioma (WHO grade III-IV) in Sweden is approximately 400 patients. The objective for the Swedish National CNS-tumor Group is to lay a foundation for research efforts and facilitate implementation and assessment of therapeutic strategies and health care for this patient group. In the analyses the diagnoses of high grade malignant gliomas are compared for the years 1999-2003, 2004-2006 and 2007-2009 for the Northern Region, the Uppsala Region and the South-east Region of Sweden, a population of 1844 patients. Survival was estimated from Kaplan-Meier survival curves, and a log-rank test was performed to assess whether the survival curves differed. The crude hazard ratio between years of diagnosis was estimated from a Cox regression model. Median survival for all patients 2004-2006 was 10.0 months (95 % confidence interval (CI) 8.9-10.9) compared to 8.1 months 1999-2003 (95 % CI 7.3-8.8). For patients 60-69 years of age almost a doubling of the survival rate has occurred during the last decade. Medan survival has increased from 5.8 months (95 % CI 5.1-7.5) 1999-2003 to 8.5 months (95 % CI 7.0-10.3) for 2004-2006 and to 10.5 months (95 % CI 9.0-12.6) for 2007-2009. Concomitant radiochemotherapy, but also the development of neurosurgical and radiotheraputic techniques and a more active therapeutic attitude, including the older patient groups, have probably contributed to the improved survival rate. A national population based registry, with a close to 100% registration compliance for important diagnostic and outcome parameters is probably an efficient instrument for evaluation of quality measures and implementation of new therapeutic strategies.

At least five per cent of the Swedish population is treated with some kind of antidepressant (AD) drug, mostly SSRI's. Sexual adverse effects, mainly loss of libido and anorgasmia or delayed orgasm/ejaculation concern more than 50% of these patients. The antidepressive effects of treatment are generally satisfying, but the sexual side effects may be a reason for non-compliance. This article refers to studies that specifically have investigated sexual adverse effects caused by AD-treatment and strategies to handle and prevent these problems. A questionnaire sent to general practitioners showed that they are well aware of the problem with sexual adverse effect in AD treatment and ascribe it great importance. The knowledge of effects and side effects of newer AD drugs seemed somewhat insufficient. An increased knowledge about these substances and alternative treatment strategies would perhaps make it easier for the physicians to handle or avoid AD induced sexual side effects.

The aim was to study if postoperative nausea after colorectal surgery could be reduced with patient-active TENS-treatment. Twenty patients with malign diagnosis, ten in a treatment group and ten in a control group, tested TENS the first two postoperative days. The patients made notes about how they used TENS and if their nausea was reduced. Nausea was diminished in both groups, which as well may indicate a placebo effect. Post-operative nausea interferes with mobilization, nutrition and rehabilitation. Since TENS is easy to use and cost-effective it is a valuable method for treatment that can be offered to patients and increase their satisfaction with care. A larger randomized study should be of value.

Rotavirus gastroenterit is the most frequent cause of severe diarrhoea in children <5 years of age. Morbidity and resource use due to rotavirus are substantial, though comprehensive data on the economic impact of the disease in Sweden are lacking. The objective of this study was to estimate the average cost per episode of confirmed rotavirus gastroenteritis in primary care, emergency department and hospital settings in Sweden. The total societal cost (including direct medical, direct nonmedical and indirect cost) per episode was estimated to SEK4307 in the primary care setting, SEK5837 in the emergency department setting and to SEK19 456 in the hospital setting. Loss of productivity due to work absenteeism among parents was one of the major costs from a societal perspective. The result shows that rotavirus incurs considerable resource utilisation in all health care settings and substantial costs for the health care sector and the society.

28. Bergqvist, David

et al.

Delle, Martin

Eckerlund, Ingemar

Marké, Lars-Ake

Säwe, Juliette

Holst, Jan

Mattiasson, Ingrid

Jogestrand, Tomas

Jörneskog, Gun

Klevsgård, Rosemarie

Rolandsson, Olov

Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.

Of 374 unselected primary care patients assessed with the Hospital Anxiety and Depression (HAD) scale, 11.8 per cent rated themselves as suffering from anxiety, and 3.7 per cent as depressed. Clinically, 8 per cent were diagnosed as cases of anxiety, and 4 per cent as cases of depression, but agreement was very poor between these cases and those elicited with the HAD scale, only 25 per cent of the latter being identified by the primary care physicians. One third of the patients with a clinical diagnosis of anxiety and 47 per cent of those with diagnosed depression were offered appropriate treatment, usually medication with a selective serotonin re-uptake inhibitor (SSRI) and consultation with a medical social worker. The results were consistent with the expected prevalences, thus indicating anxiety and depression to be markedly under-diagnosed and under-treated, and suggest that there is a manifest need of consultation facilities and of further education among primary care physicians.

About 15% of primary care attenders suffer from depression, yet only a minority are identified and treated. It is of major importance to spread knowledge of the prevalence of depression and tools for recognizing the disorder. Most patients can be successfully treated in a primary care setting. Studies have shown that educational efforts and close cooperation between psychiatrists and general practitioners (GP's) lead to an increase in the proportion of depressed patients that are identified and properly treated. The use of diagnostic self-reports can facilitate this process for the GP. It is crucial to identify and treat the disorder early on, in order to improve prognosis, decrease the risk of complications and reduce costs for society and the health care system. The article reviews recent studies concerning depression in primary care, describes relevant diagnostic tools and discusses treatment strategies, including self-care and St Johns' wort.

About five percent of the Swedes are treated with antidepressants, mostly SSRI:s. One third of those are non-responders. In that situation augmentation with a noradrenergic drug, such as reboxetine, can be a successful treatment strategy. This paper discusses clinical and scientific experiences of combinating SSRI:s and NRI:s.

39.

Boman, Jens

et al.

Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.

Nylander, Elisabet

Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.

After a delay of nearly 40 years the correct diagnosis was finally elucidated. The cause of the patients's heart failure was an arterio-venous fistula resulting from a previous spleenectomy. After embolization of the fistula the patient was relieved of her heart failure symptoms with a successful discontinuation of the pharmacological therapy